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1、.Organizational Review CommitteeAlternative Solution RankingSeptember, 2004V0004*;Table of ContentsINTRODUCTION2ALTERNATE SOLUTION EVALUATION3Legend3Scoring Matrix3Comments12APPENDIX A - APPROACH1APPENDIX B - ISSUES2APPENDIX C - ROOT CAUSE ANALYSIS6Business Value/ROI6V3 Content - Completeness7V3 Con

2、tent - Semantic Interoperability8Methodology (Holes, Tools)8Process Maturity9Balloting9HL7 Business Model10Internationalization10Resources11HL7 Education (Intra and External)11IntroductionDuring the San Diego Working Group Meeting, 2004, the Board initiated a committee, the Organization Review Commi

3、ttee (ORC), to:Ø Analyze a myriad of issues that have been raised in recent past that impact the effectiveness and efficiency of the organization as a whole to develop standards, V3 in particular; and Ø Provide recommendations to the Board how to address these issues through specific proce

4、ss and/or organizational enhancements.The committee is ready to share with you the many ideas that have been generated and would like to receive feedback from you to help narrow down these ideas to those that are really important to you and HL7 to make significant progress in improving the processes

5、, organization, and ultimately the output in terms of approved standards.To that end you will find a matrix on the next pages of alternate solutions that we would like you to rank. Before ranking them though, you may want to read the appendices that provide background on the process followed and the

6、 issues identified.Please provide feedback through the list by October 15 to ensure your thoughts are included.Thank you!ORCØ Chair: Mark Shafarman, Hans Buitendijk Ø Members: Jane Curry, Freida Hall, Dick Harding, Mike Henderson, Kai U. Heitmann, Virginia Lorenzi, D

7、avid Markwell, Charlie Mead, Helen Stevens, Ken Rubin, and Gavin Tong.ORC FindingsPage 2 of 28V0003Alternate Solution EvaluationThe following reflect the alternate solutions identified as we reviewed potential ways to address the root causes. The alternate solutions are organized by root cause categ

8、ory that are further described in Appendix C Root Cause Analysis.LegendORC FindingsPage 13 of 28V0003To determine whether an alternate solution is viable to be pursued as a recommendation, we established a number of principles and objectives that these alternate solutions must be measured against. T

9、he following represents these principles/objectives.1. Support the creation and maintenance of interoperability standards that have high probability of successful implementation.2. Increase probability of successful roll-out of the recommended organizational and process changesa. Minimal roll-out ef

10、fort3. Support culture of collaboration and consensus4. Improve organizational efficiency/effectivenessa. Reduce duplication of effortsb. Increase cohesion of the specifications developed (along a maturity curve)5. Provides clearly recognized benefits to the contributing organization(s)a. Note: diff

11、erent benefits to different organization types, e.g., provider, government, vendor, consultants, international affiliates, etc.6. Ensure coherence of the proposed set of solutionsa. Keeping focus on the big picture rather than piecemeal addressing of individual issues.For each of alternate solution

12、lines that are not shaded, we ask you to score the impact on the principles/objectives in two ways:Ø Priority (P)1 through 3 (1-Essential; 2 Desirable; 3 Would be Nice)Ø Threshold (T) Distribute 50 points within the column based on most important item to support one or more principle/objec

13、tive. Total points distributed within that column may not exceed 50. You may allocate all points to one solution.Scoring MatrixIDAlternate SolutionRankingPTBusiness Value/ROI1.1Improve communication (external and internal)1.1.1Ø Re-fresh and/or clearly articulate the vision of HL7 and make it s

14、pecific to V2 and V3, as well as other initiatives (EHR, CCOW, etc.)q Agree to the V3 Value Proposition visa vis V2. Decide whether V3 is the fix for V2 or not, a replacement for V2 or not, and what the extra values are.q Define specific benefits for V2 and V.4q Clarify whether

15、we are making course corrections, or charting a new course. If it's the latter insure the general membership understands how to have input into the decision.1.1.2Ø Create a message to all stakeholders on the value of participating to their organizations. This message must address the actual

16、 volunteers and the organizations they represent.Ø Clarify to potential participants (individuals and organizations) the different forms and degrees of participation in HL7 and the value proposition associated with each to the participants and HL.1q Develop the ROI story as tool for volu

17、nteers to negotiate with their employers for increased volunteerism.q Get quotes from benefactors and other key stakeholders.q Publish a “glossy” for each stakeholder group.q Publish a message as a paper and/or on the website.1.2Consider/Execute Marketing recommendations1.2.1

18、16; Review prior principles and marketing materials and revise. Publish the revision, with period updates reporting progress towards goals.1.2.2Ø Define clear channels/instruments to communicate vision, e.g., press release, articles, presentations, etc. for the right audiences.1.2.3Ø Devel

19、op newscasts/updates which can be downloaded for free from the HL7 web (e.g. similar to the HIMSS presentations.) Perhaps include a quarterly update on v3 (AND v2).1.2.4Ø Create newsletter articles by various early adopters.1.3Institute Governance principals1.3.1Ø Develop a business plan s

20、ubject to periodic evaluation.1.3.2Ø Define carefully considered promises that we can fulfill.1.3.3Ø Stop V2 development, short of technical corrections and regulatory requirements, or define a strategy for continued development.V3 Content2.1Refine Project Management approach to V3 Ballot

21、content:2.1.1Ø Clearly define a project plan consistent with anticipated availability of resourcesq Selecting the priority work items is a complex taskq Establish and publish a conservative timeline and manage to it2.1.2Ø Develop detailed Scope statementsq For targeted

22、 completion by January 2005 WGMq For V3 release 12.1.3Ø Control Scope creep.2.1.4Ø Encourage volunteers to concentrate on the priority work items, or to contribute to them if their major interest lies elsewhere.2.1.5Ø Explore opportunity to solicit from individual participants

23、more specific project contributions to facilitate clearer communication and expectation setting regarding who is available when.2.1.6Ø Ensure that project activities are well defined at reasonably sized “chunks”, including skill sets required, level of effort involved, critical paths and timeli

24、ne, and then advertise the activities to solicit volunteers.q Take advantage of tooling to support documentation and communication process.2.1.7Ø Pull back and re-focus on what we are trying to accomplish and adjust accordingly.q Compare V3 with V2 to identify the delta still to b

25、e covered.2.1.8Ø Develop domains that are in demand for in v3 rather than domains that exist in v2 where there is less demand.2.2Task a permanent group to deal with cross-domain inconsistencies:2.2.1Ø Proactivelyq Identify where different groups are potentially covering the same tec

26、hnical issue (committees, affiliates, SDOs) based on membership inputq Encourage cooperation between HL7 groups Clinical Statement is a positive example.q Commission tooling to stop some inconsistencies from occurring.2.2.2Ø Retroactivelyq Encourage balloters to compare acr

27、oss domainsq Encourage MnM to work with committees to review how the methodology was implementedq Create a mechanism for ballotters to vote negative on cross-domain inconsistenciesq Devise a mechanism to reconcile cross-domain inconsistencies that are binding across domains base

28、d on the principles of consensus. There needs to be a recognition that sometimes the reconciliation is not to arrive on one solution, rather enable multiple solutions with documented rational why/when to use one vs. the other.2.2.3Ø Create harmonization process/structure/ whatever to synchroniz

29、e business focused projects. “TC” chairs manage projects and harmonize across their projects. TSC is meeting of TC chairs to synchronize project initiation and scope.q Expand the "ARB" for cross-domain review and proposals. We should be very considerate about who should be on the AR

30、B if we expand/open the role?q Merge MnM and ARB, or split the scope betterq Morph ARB into a 'facilitator' role between committees and have a larger membership rather than being the closed group it is now.q Consider elected/open representation. One open and one appointe

31、d co-chairq Conduct a "mini-TSC" council meeting Q4 each day (each committee must send an empowered representative) and this is where cross-domain issues are worked out. (Perhaps ARB, MnM, or newly created arbitration panel adjudicates.) q Expand the role of ARB.q Cons

32、ider the Working Group 6 approach as used in DICOM as peer group. X12 architecture group.2.3Establish a cross-domain reconciliation process/group responsible to triage issues, create an action plan, and produce documentation of the reconciliation solution.2.3.1Ø Compare variants to identify why

33、 they ended up differently.2.3.2Ø Create better examples to help narrow interpretations.Methodology (Holes, Tools)3.1Update the HDF.3.1.1Ø Focus on sections/components that are essential to accelerated delivery of V3 and necessary to fulfill contractual commitments.3.1.2Ø Incorporate

34、external party evaluation process into HDF core processes to avoid surprises.3.1.3Ø Integrate HDF into a synchronized, consistent document.3.1.4Ø Deploy HDF and educate constituents on its use for completed chapters (in particular Chapter 2).3.1.5Ø Institute more formal processes to i

35、dentify, document, and roll-out methodology changes.3.2Adapt the V2 proposal database for V3 and train co-chairs how to use it.3.3Improve the ease of creating V3 content3.3.1Ø Make tools easier to use3.3.2Ø Hide tools wherever possible - ballot material should be editable in common editors

36、 and instantaneously available for preview (previewing of the material should not require publishing committee involvement). 3.3.3Ø Enhance the tools to enforce standard behavior and compliance3.3.4Ø Create a post-ballot review to formally assess how this ballot is consistent with its peer

37、s.3.3.5Ø Create tools and volunteer roles that allow more than the domain content creator to add value to a V3 domain. This will also ultimately increase the pool of domain content creators.3.3.6Ø Involve more V2 experts and healthcare domain experts for help with material review, scope de

38、finition, examples creation to drive towards easier to understand explanations.3.4Improve the ease of understanding V33.4.1Ø Make existing content easier to understand3.4.2Ø Provide examples of structures showing the unrolling and constraint language in the documentation, somewhere. E.g.,

39、batteries, micro.3.5Create an Implementation Guide for V33.5.1Ø Use Mead Walker's HIMSS documents and The Netherlands' examples as template for implementation guide publication standards.3.5.2Ø Define a migration path from V2 to V3. What is involved. When to do it. Etc.q Add

40、 V2 references to all HMD elements and trigger events, where applicableq Add V2 examples for all V3 examples (where applicable).q V2 volunteers should be solicited to help with these efforts.q As much as possible, create a “map” of V2 content and concepts to V3 Note that a compl

41、ete 1:1 field level mapping is not possible, even with a specific implementation in mind. Therefore a “map” can only consist of guidelines and maps based on specific implementations where possible. 3.6Collaborate with IHE to resolve specific implementation profiles while HL7 ensures inter-enterprise

42、 semantic interoperability.3.7Extend and increase the use of conference calls.3.7.1Ø Improve notification of conference calls, e.g., conference call schedule on the website.3.7.2Ø Write something in the HL7 newsletter about their existence.3.7.3Ø Procure access to webex (or equivalent

43、)Process Maturity4.1Cross committee Management4.1.2Ø Establish a ballot and committee process to address the ownership “confusion” between ARB, MnM, and Publishing.4.2Workgroup Management4.2.1Ø Provide guidelines on what to address during workgroup committee meetings and what during confer

44、ence calls or other media.4.2.2Ø Create alternative, formal and rigorous processes to obtain feedback and input outside of meetings., etc. as alternatives to resolving issues through ballot.q Introduce peer reviews.q Public comment periods.q Promote use of “draft for commen

45、ts”4.2.3Ø Expand the agenda template to include a review of mission/scope and decision making document at the beginning of each workgroup. This "grounds" the committee philosophically and is a built in review cycle for update4.2.4Ø Spend less time on ballot reconciliation and dev

46、eloping content; Spend more time on getting the fundamentals correct. Until then all content can only be a pre-standard (DSTU). This will require definition of the set of artifacts that ensures the V3 fundamentals are correct.4.3Early Adopters Management4.3.1Ø Ensure early implementation feedba

47、ck is incorporated into the standard as a matter of course to maintain realistic approach.4.3.2Ø Provide "Show and Tell" education re: Freida Halls v3 implementation.Balloting5.1Improve quality of balloted material5.1.1Ø Facilitate group ballot reads during a ballot cycle, using

48、conference calls or webex sessions to educate balloters on what the ballot content is. Publicize these sessions on the ballot site to get more involvement.5.1.2Ø Ensure the Ballots enshrine the V3 principles and style guide.5.1.3Ø Facilitate cross-domain review and harmonization of ballot

49、content.5.1.4Ø Establish an independent quality committee to ensure that ballots have addressed known issues; this will minimize the burden on the general membership.5.1.5Include a questionnaire in each ballot to solicit feedback on what can be done to improve on the ballot process.5.1.6Ø

50、Promote the practice of pre-ballot reviews of content to promote early consensus and reduce burden in the formal ballot comments period. Practices such as peer reviews and “for-commentballot” documents are examples of approaches that will result in cleaner committee ballot materials.5.2Reduce ballot

51、 fatigue5.2.1Ø Re-assess the Cost/Value of the current frenetic ballot cycle.5.2.2Ø Reduce scope/quantity but improve effectiveness of ballot cycles.5.2.3Ø Institute a one-cycle moratorium (at least) on balloting, and the effort saved should be devoted entirely to documenting and achi

52、eving BROAD consensus (i.e., more than the cognoscenti) on the V3 development and localization process.5.2.4Ø Limit ballots to one every two Working Group Meetings. This Implies one WGM for ballot resolution and the next WGM for domain content upgrade.5.2.5Ø Sequence ballot content across

53、ballots to enable focus and avoid volunteers having to make tough participation choices. The sequencing is based on dependencies and domain expert overlaps.5.3Refine project management of V3 Ballot content5.3.1Ø Determine what V3 subset of goals is feasible, establish a conservative timeline, a

54、nd manage to it. This requires buy in from the volunteers and their organizations. Established deadlines must be met.5.3.2Ø Organize the ballot cycle around what HL7 believes the right sequence and content should be. Do not disallow other parties to still meet and progress, just don't allow

55、 them to ballot yet.5.3.3Ø Determine priorities and focus on select work products to be completed by HL7 over a specified timeframe.5.3.4Ø An ability to plan the content of the ballot on the basis of:q The ability to prioritize our efforts.q The ability to ensure semantic int

56、eroperability across the current TC and SIG-defined domains.q A formal process is needed to review and approve items proposed for ballot on the basis of:.1o Priorities..2o Overlap with existing items (and previously balloted items that may not be on the proposed ballot)..3o Semantic interoperability with existing items.5.4Resolve technical ballot issues.5.4.1Ø Create a mechanism to vote negative on cross domain issues. 5.5Address ballot vs. new content balance5.5.1Ø Change the schedule of workgroup meetings to alternate focus on ballot reconcilia